Mini-strokes 101

Hope, read my comment to your question on "immovable object."

There are more nerve connections in the brain than there are stars in the universe. Each nerve cell is ultimately fed by blood vessels that would make a human hair look thick. This is why a person can have so very many mini-strokes, as Helen has had, and because they are so tiny, why the person never knows it even is happening, nor does anyone else. What showed up on the CAT scan were the dead brain cells whose blood supply was cut off by one of these mini-strokes. Depending on which of these countless cells dies, let's say it's the cell that knows my phone number, Helen would no longer be able to remember it.

To complicate matters, all of these nerve cells are interconnected, so that a particular system, let's say the one that governs Chuck's name loses a cell vital to that connection, she'll not remember Chuck's name, as she did with me day before yesterday. Fortunately there are a lot of "connections" that can also remember the name "Chuck," only by a different pathway with different associations. Your mom has AD and, as we all suspected, severe vascular dementia.

What worries me is that Alzheimer's is a slow, steady process and vascular dementia, that is a new mini-stroke, often produces an instantly recognizable change, and I think your mom has had several this week. She's not like she was last week. She seems more readily "lost" and wandering around. Also, new things (like going to the Doctor or a wedding) will produce the same confusion....something that's out of her comfort zone, something "new" where she has to reason out, like tonight, how to get ready for a wedding. It could be both AD and Vascular dementia to blame for this. She was clearly agitated, but not in a nasty way.She put on her High heels and then wondered aloud how she was going to get her bluejeans off over them. It never entered her mind to remove the shoes first. Lesson: Explain in detail when you are getting her out of her comfort zone what you are doing and why. She may understand, she may not.

There are mini-strokes, strokes, and massive strokes. Helen has the first one. In spades. She has probably been having them for years. The second would only serve to paralyze her, God forbid. The third will send her on to Greener Pastures. Strokes generally, but not always, happen at night while the person is asleep, I think I told you all that. My best guess is that since she walks so little, clots will form in the vessels behind the knee and will at sometime break off ("throwing an embolus") and, due to it's size will lodge in a brain vessel that feeds life-sustaining cells and she simply won't wake up. Then again, she might outlive us all. God Knows.

It's because there are trillions of connections in the brain that even evidence of massive mini-strokes having taken place plus the ability of the healthy parts of the brain to do "double duty" that your mom's behavior doesn't act like what it looked like it should be having viewed the CAT scan. Your mom always had an exceptionally good head on her shoulders, so I, for one, am not surprised. R.